Why 11-beta-hydroxylase deficiency causes hypertension even though it results in reduced aldosterone synthesis:
" because of overproduction of cortisol precursors that are, or are metabolized to, mineralocorticoid agonists." Source
[!INFO] Mnemonics
REDMAN or SCALP-ID
REDMAN : Eczema / psoriasis, Drugs, Malignancy (mycosis fungoides, CTCL, Autoimmune, No identifiable cause)
SCALP-ID
- Normally, the kidney deactivates cortisol via the enzyme 11-beta-dehydrogenase isozyme 2 to inactive cortisone, thus 'protecting' it's mineralocorticoid receptors from the effects of cortisol. Source
- In ectopic ACTH mediated Cushing's syndrome, this inactivation is overwhelmed and cortisol acts on the aldosterone receptors -> producing hypokalemia.
- #2021GM-JUL/Q16 Deficiency of 11-beta-dehydrogenase occurs in "apparent mineralocorticoid excess".
#2021GM-JUL/Q16
[!TIP] Mnemonic: Similar to Conn's syndrome but with low renin and aldosterone.
Caused by deficiency of 11-beta-dehydrogenase.
Features:
Hypokalemia
Metabolic alkalosis
Low plasma renin activity
Low plasma aldosterone levels
Chronic liquorice (licorice) ingestion causes a similar picture. It inhibits 11-beta-dehydrogenase.
Organism excreted via urine of infected animal. (Only a minority of humans excrete organisms in urine - that's from second week onwards)
Usually non-oliguric and hypokalemic.
⭐Definition of AIDS :
| cystoisosporiasis | Cryptosporidosis | Cryptococcosis | Coccidioidomycosis | Candidiasis | Histoplasmosis |
|---|---|---|---|---|---|
| Protozoan | Protozoan | Fungus | Fungs (valley fever) | Yeast | Fungus |
| Water diarrhoea | Most common cause of infective diarrhoea in HIV | Common: Second leading COD in AIDS | |||
| "SPO" - protozoan with diarrhoea | "SPO" - protozoan with diarrhoea | Starts with pulmonary infection | Starts as pulmonary infection; | Chronic, tuberculosis like lung infection in AIDS patients; otherwise cleared easily | |
| extrapulmonary is aids defining | extrapulmonary is aids defining | Invasive disease is aids defining | Chronic pulmonary infection is AIDS defining | ||
| Causes fatal meningitis | |||||
| Common (Even on HAART) | |||||
| Reservoir: soil containing bird droppings | |||||
| Diagnosis: stool microscopy for cysts | Diagnosis: Stool microscopy for cysts |
Comparison of some medically important streptococci
[!TIP] Common terminology
- Pyogenes = GABS, Group B strep - Agalatiae; Pneumococcus = Strep pneumonia.
| Feature | Strep pyogenes | Strep agalactiae | Strep Viridans | Strep pneumonia |
|---|---|---|---|---|
| AKA | Viridans Group Strep | Pneumococcus | ||
| Clinical manifestation |
Pharyngitis, Scarlet fever, Soft tissue infection |
Neonatal infection, adult pelvic infection |
Endocarditis | Pneumonia |
| Complications | Rheumamtic fever, PSGN, PANDAS | |||
| Haemolytic typee | Beta | Beta | Alpha | Alpha |
| Lancefiled Group | A | B | None | None |
| Morphology | Chains | Chains | Diplococci / chains | |
- [[Nephrology miscellaneous#Membranoproliferative glomerulonephritis|Membranoproliferative(aka mesangioproliferative,
aka mesangiocapillary) glomerulonephritis]]
[!INFO] Membranoproliferative and Mesangioproliferative are described under "acute nephritic syndromes" in Harrison's
This probably means they present more often as nephritic syndromes but also can have some proteinuria.
There is (From Harrison's)
| Dense deposit disease | C3 glomerulonephritis |
|---|---|
| Defined by presense of ribbon like dense deposits in the GBM. | Similar but no ribbons |
| Children and young adults | mean age 30 |
| Proteinuria + haematuria (nephrotic range proteinuria in 1/3) | haematuria and 1/3 have proteinuria |
| Poor prognosis : half develop CKD. | ?? |
| Normal complement levels | Low complement levels |
|---|---|
| Visceral abscess | ⭐Cryoglobulinaemia |
| [[Miscellaneous respiratory medicine#Polyarteritis nodosa (PAN)|Polyarteritis nodosa]] | SLE |
| [[2022 November SBR#Goodpasture's syndrome|Goodpasture's Syndrome]] | ⭐Bacterial endocarditis |
| Henoch-Schonlein purpura | ⭐Shunt nephritis (VP shunts) (i.e infected shunt) |
| ==Sometimes MPGN== | |
| ==and PSGN== |
The surprising ones are highlighted; basically, myopathies tend to cause proximal symmetrical weakness; distal weakness is more likely due to nerve issues.
These are the Dermatoses which almost always occur with a malignancy.
| Lesion | Association | Mnemonic |
| ------------------------------------ | ----------------------------------------------------------- | ----------------------------------------------------------------------------- |
| Tripe palm (aka pachydermatoglyphia) | Lung cancer, gastric cancer | Occurs together with ANM |
| Acanthosis nigricans Maligna (ANM) | Gastric Adenocarcinoma | AN is connected to things relating to fat / stomach / tummy |
| Erythema gyratum repens | pulmonary, oesophageal, breast | Forests (wood grain appearance of rash) are the lungs of the world |
| Acquired hypertrichosis lanuginosa | colorectal, pulmonary and breast | Hairy butt |
| Bazex syndrome | Aerodigestive | |
| Acquired ichthyosis | Lymphoma | Lymfishma |
| Dermatomyositis | Ovarian Ca, Lung CA | Common in women -> ovaries.
Also, lungs
Associated with "paired organs" |
| Migratory thrombophlebitis | Pancreatic CA | Let's assume scorpion stings also case thrombosis |
| Necrolytic migratory erythema | Glucagonoma | Always carry glucose while migrating |
| Pyoderma gangrenosum | myeloproliferative disorders | pyo/myo |
| Sweet syndrome | Haematologic malignancies | Sweets raise blood sugar |
| Tylosis | Oesophageal cancer | Tie a tie around the oesophagus |
| Leser-Trelat | Gastric and colorectal | |
| Paraneoplastic pemphigus | NHL, CLL, Castleman Disease, Thymoma | |
| Pytiriasis rotunda | Hepatocellular carcinoma, gastric and oesophageal carcinoma | |
| Palmoplantar keratoderma | Oeseophageal SQC | |
| Pyoderma gangrenosum | | |
| Sweet syndrome | AML, MDS, | |
| pyoderma gangrenosum | MDS, myeloma, leukemia | |
Bazex syndrome
Pytiriasis rotunda

Necrolytic Migratory Erythema
| Dermatologic condition | Associated |
|---|---|
| Hyperkeratotic and proliferative dermatoses | - |
| [[2022 General Medicine Paper-May#Acanthosis nigricans]] | |
| Florid cutaneous papillomatosis (rapid eruption of warts) | Stomach cancer |
| Sign of Leser-Trelat (rapid appearance of seborrheic keratoses) | Gastrointestinal adenocarcinoma AND many others |
| Tripe palm (velvety thickening of palmar skin) | Gastric or lung cancer |
| Icthyosis | Hodgkin's lymphoma |
| Palmoplantar keratoderma | Associated with SQC of oesophagus = Howel-Evans Xn |
| Bazex Xn: psoriatic like plaques on fingers and toes (acrokeratosis paraneoplastica | SQC of aerodigestive tract |
| Inflammatory dermatoses - erythematous or violaceous skin eruptions | |
| Sweet syndnrome (dermal,non vasculitic neutrophil infiltration with fever + neutrophilia) | Acute myeloid leukemia, lymphoma |
| Dermatomyositis | Ovarian, breast, cervical,uterine + others |
| Erythroderma (usually caused by psoriasis or atopic dermatitis) | Cutaneous T cell lymphoma |
| Erythroderma gyratum repens | Bronchogenic carcinoma |
| Pancreatic panniculitis | Pancreatic cancer |
| paraneoplastic pemphigus (PAMS) | Non-hodgkin lymphoma, CLL |
| Mucous Membrane pemphigoid | Unspecified but associated with malignancy |
| - | |
| Hyperpigmentation | |
| Hyperpigmentation in ectopic ACTH poduction (ectopic cushing's syndrome) | Small cell lung CA |
| ( POMC produced by the tumour is a precursor of ACTH and MSH ) | |
| Generalized dermal melanosis | Extensive metastatic melanoma |
| Skin manifestations of amyloidosis [[2022-November#Amyloidosis]] | plasma cell dyscrasias such as multiple myeloma, and less frequently, Waldenström macroglobulinemia |
Type 1 = H+ secretion defect in DCT.
| Type 2 | Type 1 | Type 4 |
|---|---|---|
| ❗Very rare❗ | Most common type | |
| Aldosterone resistance of CD | ||
| Sjogren | Diabetic nephropathy | |
| Fanconi Syndrome | Rheumatoid Arhtitis | Chronic interstitial nephritis |
| ⭐Light chain nephropathy | Cirrhosis | ACEi use, Heparain and enoxa,NSAIDS |
| i.e 👆🏼Myeloma | Sickle cell anaemia | K+ sparing diuretics |
| Acetazolamide, Topiramate | Kidney transplant | CAH, primary adrenal insufficiency |
| [[Gastroenterology MCQ discussion#Q 13 Wilsons disease]] | Amphotericin B, lithium | |
| Secondary hyperparathyroidism | ||
| Heavy metals | ||
| ⭐Cystinosis |
Basis is hyperkeratosis and epidermal papillomatosis as seen on histology. Black color is not due to melanin but due to the hyperkaratosis. Source
Endocrine (Cushing's and Acromegaly)
N if for iNjected Insulin and other drugs
aka acute febrile neutrophilic dermatosis.
(Both (AL and AA) have the beta pleted sheet structure) (Harrison's - page 804)
The symptoms and signs of AL and AA cannot reliably be distinguished. - Harrison's
- Newborns: Group B Streptococcus, S. pneumoniae, L. monocytogenes, E. coli
- Babies and young children: S. pneumoniae, N. meningitidis, H. influenzae, group B Streptococcus, M. tuberculosis
- Teens and young adults: N. meningitidis, S. pneumoniae
- Older adults: S. pneumoniae, N. meningitidis, H. influenzae, group B Streptococcus, L. monocytogenes
Source